Exploring influences of the socio-ecological environment on the Queen Club program for adolescent girls in Tanzania

总结 撒哈拉以南非洲的少女和年轻妇女（15-24岁）面临艾滋病毒的双重威胁 感染和意外怀孕严重损害了她们的长期健康。但尽管 由于迫切需要向青年女青年提供性健康和生殖健康服务， 青年妇女协会有能力克服其在获得保健服务方面面临的众多障碍。这项研究的目的是 评估坦桑尼亚的Malkia Klabu（“女王俱乐部”），这是一个忠诚计划干预，创建了AGYW- 友好的药店，青年女青年协会可以在那里获得艾滋病毒预防服务和避孕药具。的动机 这种方法是越来越多的人认识到，药店分布广泛，数量远远超过 卫生设施，可以促进有益的健康行为，弥合卫生服务的差距，并减轻健康 劳动力短缺。此外，虽然艾滋病毒检测是艾滋病毒预防和护理的门户，但自我检测 尽管整个地区的政府都采用了口服液，但AGYW并没有广泛采用。 基于一项试点研究的有希望的数据，我们假设创造一个友好的环境 通过Malkia Klabu的干预措施，将吸引AGYW，并促进包括艾滋病毒在内的性健康和生殖健康服务的接受 自我检测（艾滋病毒/艾滋病检测）工具包和避孕药具，从而提高了认识到自己的艾滋病毒/艾滋病问题的青年女青年的比例。 艾滋病毒状况，并有权避免意外怀孕。我们设计了一种创新的混合方法， 评估Malkia Klabu干预措施的研究，该干预措施是为青年协会设计的，由青年协会设计，目的是创造有利于青年协会的环境 在药店里，艾滋病毒/艾滋病防治与避孕和护理联系在一起。具体来说，我们的5年研究 包括在40个卫生设施集水区进行的一项群集随机试验（C-RCT），以评估干预措施的 在人口一级，青年女青年协会在艾滋病毒诊断和产前护理登记方面的效力（目标1）。 然后，我们将这些结果与个人层面的行为联系起来（例如，最近的艾滋病毒检测， 避孕、与护理的联系）和其他需求方途径对RDS调查产生影响， 与青年妇女咨询小组的焦点小组（目标2）。最后，一个混合方法，实施科学研究将查明供应- 影响有效性的副因素（例如，实施模式、干预保真度、商店特征; 目标3）。在研究结束时，我们将严格评估Malkia Klabu，发现 提高计划的成功，并描述了与实施一致的潜在影响途径 科学的方法来缩小证据和实践之间的差距。该研究团队是一个合作 加州大学（旧金山弗朗西斯科和伯克利），健康繁荣的国家， 坦桑尼亚卫生、社区发展、性别、老年人和儿童部和坦桑尼亚 药学理事会。 拟议的研究将首次严格探讨是否可以利用对青年志愿者友好的药店 向女青年协会提供艾滋病毒预防和性健康和生殖健康服务， 分发工作值得扩大规模，以覆盖坦桑尼亚和该区域的弱势青年妇女。

SUMMARY Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face the dual threats of HIV infection and unintended pregnancy that severely undermine their long-term wellbeing. However, despite the urgent need to reach AGYW with sexual and reproductive health (SRH) services, health systems are often ill equipped to overcome the numerous barriers to health care services faced by AGYW. The goal of the study is to evaluate Malkia Klabu (“Queen Club”) in Tanzania, a loyalty program intervention that creates AGYW- friendly drug shops where AGYW can access HIV prevention services and contraception. The motivation for this approach is the growing recognition that drug shops, which are widely distributed and vastly outnumber health facilities, can promote beneficial health behaviors, bridge gaps in health services, and mitigate health workforce shortages. Furthermore, although HIV testing is the gateway to HIV prevention and care, self-testing with oral fluid has not been widely adopted by AGYW, despite government adoptions across the Region. Based on promising data from a pilot study, we hypothesize that the creation of a welcoming environment through the Malkia Klabu intervention will attract AGYW and bolster uptake of SRH services, including HIV self-test (HIVST) kits and contraception, thereby increasing the proportion of AGYW who are aware of their HIV status and empowered to avoid unintended pregnancy. We have designed an innovative, mixed-methods study to evaluate the Malkia Klabu intervention, which was designed for and by AGYW to create AGYW-friendly drug shops where HIVST is available alongside contraception and linkages to care. Specifically, our 5-year study includes a cluster-randomized trial (C-RCT) in 40 health facility catchment areas to evaluate the intervention’s effectiveness on HIV diagnoses and antenatal care registrations among AGYW at the population level (Aim 1). We will then link these outcomes to individual-level behaviors (e.g., recent HIV testing, unmet for contraception, linkage to care) and other demand-side pathways leading to impact with a RDS survey and focus groups with AGYW (Aim 2). Finally, a mixed-methods, implementation science study will pinpoint supply- side factors influencing effectiveness (e.g., implementation models, intervention fidelity, shop characteristics; Aim 3). At the study’s conclusion, we will have rigorously evaluated Malkia Klabu, uncovered factors that enhance program success, and described potential pathways of impact, consistent with an implementation science approach to close the gap between evidence and practice. The research team is a collaboration between the University of California (San Francisco and Berkeley), Health for a Prosperous Nation, the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children, and the Tanzania Pharmacy Council. The proposed study will rigorously explore, for the first time, whether AGYW-friendly drug shops can be used to distribute HIV prevention and SRH services to AGYW and whether this community-based platform of distribution is worthy of scaling to reach vulnerable AGYW across Tanzania and the Region.